Zhang Ye,You Long,Jiang Jiabin,et al.Comparison of therapeutic efficacy of two kinds of skin flap covering for severe concealed penis in children[J].Journal of Clinical Pediatric Surgery,,20():852-856.[doi:10.12260/lcxewkzz.2021.09.010]
Comparison of therapeutic efficacy of two kinds of skin flap covering for severe concealed penis in children
- Keywords:
- Penis/AB; Surgical Flaps; Surgical Procedures; Operative; Comparative Effectiveness Research; Child
- CLC:
- R726.971.1;R726.9
- Abstract:
- Objective To explore the therapeutic efficacy of transverse pedicled island flap versus proximal propulsion skin flap covering for severe concealed penis in children.Methods Clinical data were retrospectively reviewed for 47 children with severe concealed penis undergoing phalloplasty between January 2019 and August 2020.The average age was 6.76 years.They were divided into group A (n=19) with transverse pedicled island flap covering and group B (n=28) with proximal propulsion skin flap covering.Operative duration, penile skin/penile shaft (S/P) ratio and complication rate were compared.At 3 months post-operation, concealed penis recovery was scored from penile exposure, foreskin appearance and penile appearance and the scores were compared.Results The average follow-up period was 7.68 months.No significant inter-group differences existed in age (t=-1.340, P=0.187) or S/P ratio (t=-0.362, P=0.720).Operative duration was significantly longer in group A than that in group B (t=4.286, P<0.001).After operation, the incidence of persistent lymphedema of prepuce in group A was significantly higher than that of group B (χ2=7.499, P=0.006) and the incidence of incision disruption in group B was significantly higher than that of group A (χ2=7.677, P=0.006).No significant inter-group difference existed in overall complication rate (χ2=0.703, P=0.402).Inter-group differences in penile exposure score, foreskin appearance score, penis appearance score and total score were not statistically significant.Conclusion Both skin flap coverings are suitable for correcting severe concealed penis in children.And proximal propulsion skin flap covering is superior since it is relatively easier to operate and achieve an excellent penile appearance.
References:
1 Spinoit AF,De Prycker S,Groen LA,et al.New surgical technique for the treatment of buried penis:results and comparison with a traditional technique in 75 patients[J].Urol Int,2013,91(2):134-139.DOI:10.1159/000351944.
2 蒋明珠,范应中,石志康.改良Devine术和改良Shiraki术治疗完全型隐匿阴茎的对比研究[J].临床小儿外科杂志,2018,17(12):902-906.DOI:CNKI:SUN:LCXR.0.2018-12-009. Jiang MZ,Fan YZ,Shi ZK.Clinical efficacy of modified Devine’s versus modified Shiraki’s procedure for completely concealed penis[J].J Clin Ped Sur,2018,17(12):902-906.DOI:CNKI:SUN:LCXR.0.2018-12-009.
3 徐奥,李雪,张志博,等.带蒂岛状包皮瓣阴茎成形术与Sugita术矫治完全型隐匿阴茎的疗效比较[J].中国修复重建外科杂志,2020,34(11):72-77.DOI:10.7507/1002-1892.202004165. Xu A,Li X,Zhang ZB,et al.Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita method for concealed penis[J].Chinese Journal of Reparative and Reconstructive Surgery,2020,34(11):72-77.DOI:10.7507/1002-1892.202004165.
4 阎景铁,张大森,李明伟.改良Devine术+包皮远端皮瓣转移治疗小儿重度隐匿性阴茎的效果[J].临床小儿外科杂志,2017,16(4):100-102.DOI:10.3969/j.issn.1671-6353.2017.04.022. Yan JT,Zhang DS,Li MW.Modified Devine OKUS plus distal skin flap transfer surgery for severe pediatric concealed penis[J].J Clin Ped Sur,2017,16(4):100-102.DOI:10.3969/j.issn.1671-6353.2017.04.022.
5 陈海琛,吴永隆,徐延波.改良Brisson术治疗重度隐匿性阴茎[J].中国修复重建外科杂志,2018,32(12):1581-1585.DOI:CNKI:SUN:ZXCW.0.2018-12-018. Chen HC,Wu YL,Xu YB.Effectiveness of modified Brisson procedure for severe concealed penis[J].Chinese Journal of Reparative and Reconstructive Surgery,2018,32(12):1581-1585.DOI:CNKI:SUN:ZXCW.0.2018-12-018.
6 Ergashev K,Chung JM,Lee SD.Concealed index for concealed penis in prepubertal children[J].Investig Clin Urol,2021,62(2):217-223.DOI:10.4111/icu.20200401.
7 Weber DM,Sch?nbucher VB,Landolt MA,et al.The Pediatric Penile Perception Score:an instrument for patient self-assessment and surgeon evaluation after hypospadias repair[J].J Urol,2008,180(3):1080-1084.DOI:10.1016/j.juro.2008.05.060.
8 Redman JF.Buried penis:congenital syndrome of a short penile shaft and a paucity of penile shaft skin[J].J Urol,2005,173(5):1714-1717.DOI:10.1097/01.ju.0000154781.98966.33.
9 Manasherova D,Kozyrev G,Gazimiev M.Buried penis surgical correction:midline incision rotation flaps[J].Urology,2020,138:174-178.DOI:10.1016/j.urology.2020.01.021.
10 Chin TW,Tsai HL,Liu CS.Modified prepuce unfurling for buried penis:a report of 12 years of experience[J].Asian J Surg,2015,38(2):74-78.DOI:10.1016/j.asjsur.2014.04.006.
11 Lei J,Luo C,Wang X,et al.A novel "six stitches" procedures for pediatric and adult buried penis[J].Int Braz J Urol,2019,45(1):190-191.DOI:10.1590/S1677-5538.IBJU.2017.0688.
12 Werner Z,Hajiran A,Al-Omar O.Congenital megaprepuce:literature review and surgical correction[J].Case Rep Urol,2019,2019:4584609.DOI:10.1155/2019/4584609.
13 de Jesus LE,Dekermacher S,Anderson KM.Severe forms of concealed penis without hypospadias:Surgical strategies[J].Indian J Urol,2015,31(4):344-348.DOI:10.4103/0970-1591.163308.
14 陈海涛,杨星海.青春期前隐匿性阴茎肉膜组织病理学分析及临床意义[J].中华男科学杂志,2013,19(3):228-231.DOI:CNKI:SUN:NKXB.0.2013-03-012. Chen HT,Yang XH.Sarcolemma tissue of prepubertal concealed pellis:Pathological characterization and clinical implication[J].National Journal of Andrology,2013,19(3):228-231.DOI:CNKI:SUN:NKXB.0.2013-03-012.
15 蒋加斌,范登信,张殷,等.横行包皮岛状带蒂皮瓣两种不同转移途径治疗儿童尿道下裂的对比分析[J].中华男科学杂志,2020,26(5):431-435.DOI:10.13263/j.cnki.nja.2020.05.008. Jiang JB,Fan DX,Zhang Y,et al.Two different routes for transferring pedicled preputial island flap for pediatric hypospadias:A comparative analysis[J].National Journal of Andrology,2020,26(5):431-435.DOI:10.13263/j.cnki.nja.2020.05.008.
16 Weber DM,Landolt MA,Gobet R,et al.The Penile Perception Score:an instrument enabling evaluation by surgeons and patient self-assessment after hypospadias repair[J].J Urol,2013,189(1):189-193.DOI:10.1016/j.juro.2012.08.178.
Memo
收稿日期:2021-04-16。
基金项目:安徽省卫生健康委课题（编号：2019SEY006）
通讯作者:潮敏,Email:cm0654@sina.com